Guidelines

Rohan Bopage1, Deborah Couldwell1, Mark Boyd2 Western Sydney Sexual Health Centre, Sydney, New South Wales University of Adelaide, Adelaide, South Australia Last reviewed: June 2021 Introduction Long term management of HIV infection encompasses the following broad objectives: Prevention of HIV disease progression and associated mortality and morbidity; Restoration and preservation of immunologic function; Prevention of …

Long-term management of antiretroviral therapy Read More »

The main objective of monitoring PWH receiving ART is to optimise the efficacy of ART while minimising ART-related adverse drug reactions and toxicities. HIV RNA (viral load) and CD4+ T cell (CD4) count are the two surrogate markers of ART response and HIV disease progression. In addition to the CD4 count and viral load, a …

Routine monitoring of PWH receiving ART Read More »

The goal of ART is to suppress HIV replication to a level below which drug-resistance mutations do not emerge within the HIV genome. Although not conclusive, most evidence suggests that selection of drug-resistance mutations does not occur in patients with plasma HIV RNA levels persistently suppressed to below 200 copies/mL, although virological suppression to below …

Virological failure Read More »

The possibility of antiretroviral drug resistance should be considered before commencing any antiretroviral drug regimen, whether initial treatment or subsequent changes in regimen, and if virological suppression is sub-optimal. When a person is newly infected with HIV, he or she may be infected with a strain that already carries drug-resistance mutations; this is known as …

Principles of managing antiretroviral drug resistance Read More »

Recovery of immune function after ART is started is variable but generally not related to the ART regimen used. Duration of the HIV infection and degree of immunodeficiency when ART is commenced (nadir CD4+ T cell count) are much more important factors. Age is another very important factor, with a slower and often blunted immune …

Immunological failure: persistent CD4+ T cell deficiency Read More »

Antiretroviral drug toxicity and DDIs are both reasons for revising an antiretroviral drug regimen but thankfully are encountered much less frequently than they were in the first two decades of ART. Detailed consideration of renal, bone, endocrine, cardiovascular disease and drug hypersensitivity reactions are covered in specific subsections of the “Co-morbidities” and “ARV drugs and …

Principles of managing antiretroviral drug toxicity and drug-drug interactions Read More »

Patient adherence to medication is the cornerstone of successful long-term treatment. Simpler dosing regimens are associated with improved adherence and virological control. Other reasons to consider regimen simplification may arise in both treatment-naïve and treatment-experienced patients, most commonly due to the presence of comorbidities, and avoidance or management of long-term toxicity and adverse effects. Decisions …

ART regimen simplification Read More »

BHIVA guidelines for the routine investigation and monitoring of adult HIV-1-positive individuals 2016 (2019 interim update). Available at:   https://www.bhiva.org/monitoring-guidelines Laboratory Testing for Initial Assessment and Monitoring of Patients with HIV Receiving Antiretroviral Therapy. US Guidelines for the Use of Antiretroviral Agents in Adults and    Adolescents with HIV. Available at:  https://aidsinfo.nih.gov/guidelines/html/1/adult-and-       adolescent-arv/3/tests-for-initial-assessment-and-follow-up European AIDS Clinical …

References Read More »